Military Health Care Team Cohesion and Performance During Simulation Training

Introduction: Military health care team cohesion has been linked to improved performance during simulation training. However, there is a gap in current research regarding the processes by which teams become cohesive within simulation training. The purpose of this study was to explore how health care teams evolve during high-fidelity simulation training and the ways in which team cohesion impacts their performance. Materials and Methods: The participants in our study were fourth-year military medical students participating in a 5-day high-fidelity military medical simulation during Fall 2022.Twenty-three students volunteered to participate in our study. We interviewed each participant twice during the simulation and then transcribed each interview using an automated transcription service. Guided by the grounded theory tradition of qualitative data analysis, we used open, axial, and selective coding to analyze the interview data. Results: Our data analysis revealed that teams went through a process of (1) struggle, (2) adaptation, (3) perceived improvement, (4) gained confidence, and (5) perceived team cohesion. Teams struggled through the various barriers to group cohesion (i.e., power dynamics, role designation and competency, and task failures and low team confidence) in order to understand their weaknesses. As teams adjusted and noticed improvement, they adapted new patterns, protocols, and standards of practice based on previous failures, improving their overall confidence. The participants perceived their teams as successful once they had progressed through these phases and ended the simulation as a cohesive unit. Conclusions: Our qualitative data analysis provided insight into team cohesion as it was forged by participants in real time as the simulation progressed. The results of our study can be used to promote team cohesion not only during simulation training but also within military health care professional teams in order to enhance their performance in the field.